<?xml version="1.0" encoding="UTF-8"?>
<table class="container" cellpadding="0" cellspacing="3">
  <tr>
    <td colspan="2" id="content">
      <div class="CLUSTER   field_91 ">
        <span class="label">Ubicacion:</span>
        <span class="content">
          <div class="ELEMENT ELEMENT_DV_CODED_TEXT field_92 field_93 ">
            <span class="label">Departamento:</span>
            <span class="content">
              <select name="field_84" id="field_84">
                <option value=""/>
                <option value="UY-AR||Artigas">Artigas</option>
                <option value="UY-CA||Canelones">Canelones</option>
                <option value="UY-CL||Cerro Largo">Cerro Largo</option>
                <option value="UY-CO||Colonia">Colonia</option>
                <option value="UY-DU||Durazno">Durazno</option>
                <option value="UY-FS||Flores">Flores</option>
                <option value="UY-FD||Florida">Florida</option>
                <option value="UY-LA||Lavalleja">Lavalleja</option>
                <option value="UY-MA||Maldonado">Maldonado</option>
                <option value="UY-MO||Montevideo">Montevideo</option>
                <option value="UY-PA||Paysandú">Paysandú</option>
                <option value="UY-RN||Río Negro">Río Negro</option>
                <option value="UY-RV||Rivera">Rivera</option>
                <option value="UY-RO||Rocha">Rocha</option>
                <option value="UY-SA||Salto">Salto</option>
                <option value="UY-SJ||San José">San José</option>
                <option value="UY-SO||Soriano ">Soriano</option>
                <option value="UY-TA||Tacuarembó">Tacuarembó</option>
                <option value="UY-TT||Treinta y Tres">Treinta y Tres</option>
              </select>
            </span>
          </div>
          <div class="ELEMENT ELEMENT_DV_TEXT field_85 field_94 ">
            <span class="label">Localidad:</span>
            <span class="content">
              <input type="text" name="field_85"/>
            </span>
          </div>
          <div class="CLUSTER   field_95 ">
            <span class="label">Via:</span>
            <span class="content">
              <div class="ELEMENT ELEMENT_DV_TEXT field_86 field_96 ">
                <span class="label">Nombre:</span>
                <span class="content">
                  <input type="text" name="field_86"/>
                </span>
              </div>
              <div class="ELEMENT ELEMENT_DV_CODED_TEXT field_97 field_98 ">
                <span class="label">Tipo:</span>
                <span class="content">
                  <label class="id_calle">
                    <input type="radio" value="at0008||calle" name="field_87"/>
calle                  </label>
                  <label class="id_ruta">
                    <input type="radio" value="at0009||ruta" name="field_87"/>
ruta                  </label>
                  <label class="id_camino">
                    <input type="radio" value="at0010||camino" name="field_87"/>
camino                  </label>
                  <label class="id_bulevar">
                    <input type="radio" value="at0011||bulevar" name="field_87"/>
bulevar                  </label>
                  <label class="id_avenida">
                    <input type="radio" value="at0012||avenida" name="field_87"/>
avenida                  </label>
                  <label class="id_paso">
                    <input type="radio" value="at0013||paso" name="field_87"/>
paso                  </label>
                  <label class="id_nr">
                    <input type="radio" checked="true" value="" name="field_87"/>
NR                  </label>
                </span>
              </div>
              <div class="ELEMENT ELEMENT_DV_COUNT field_88 field_99 ">
                <span class="label">Numero:</span>
                <span class="content">
(*..*)                  <input type="text" name="field_88"/>
                </span>
              </div>
            </span>
          </div>
          <div class="CLUSTER   field_100 ">
            <span class="label">Cruce:</span>
            <span class="content">
              <div class="ELEMENT ELEMENT_DV_TEXT field_89 field_101 ">
                <span class="label">Nombre:</span>
                <span class="content">
                  <input type="text" name="field_89"/>
                </span>
              </div>
              <div class="ELEMENT ELEMENT_DV_CODED_TEXT field_102 field_103 ">
                <span class="label">Tipo:</span>
                <span class="content">
                  <label class="id_calle">
                    <input type="radio" value="at0008||calle" name="field_90"/>
calle                  </label>
                  <label class="id_ruta">
                    <input type="radio" value="at0009||ruta" name="field_90"/>
ruta                  </label>
                  <label class="id_camino">
                    <input type="radio" value="at0010||camino" name="field_90"/>
camino                  </label>
                  <label class="id_bulevar">
                    <input type="radio" value="at0011||bulevar" name="field_90"/>
bulevar                  </label>
                  <label class="id_avenida">
                    <input type="radio" value="at0012||avenida" name="field_90"/>
avenida                  </label>
                  <label class="id_paso">
                    <input type="radio" value="at0013||paso" name="field_90"/>
paso                  </label>
                  <label class="id_nr">
                    <input type="radio" checked="true" value="" name="field_90"/>
NR                  </label>
                </span>
              </div>
            </span>
          </div>
        </span>
      </div>
    </td>
  </tr>
  <tr>
    <td id="left"/>
    <td id="right"/>
  </tr>
  <tr>
    <td colspan="2" id="bottom"/>
  </tr>
</table>
